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BIOPTICS THE SOUTH AFRICAN WAY

BIOPTICS THE SOUTH AFRICAN WAY. ALLAN KAYE RODNEY STEDALL Assisted by Hazel Sacher. SOUTH AFRICA 2010. PROBLEMS PRESCRIBING BIOPTICS. Driving decisions are based on vision

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BIOPTICS THE SOUTH AFRICAN WAY

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  1. BIOPTICSTHE SOUTH AFRICAN WAY • ALLAN KAYE • RODNEY STEDALL • Assisted by Hazel Sacher

  2. SOUTH AFRICA 2010

  3. PROBLEMS PRESCRIBINGBIOPTICS • Driving decisions are based on vision • Standard tests in current use are unreliable in predicting unsafe driving • A driving license is a privilege and not a right • A heavy onus is placed on the optometrist to make a decision on whether the client will be a safe driver • Paucity of training facilities • Cost / medical aid

  4. THE BIOPTIC STUDY ABK RS BH Total prescribed 30 30 21 Age range 12 - 71 17 – 75 14 - 74 Mean age 41.5 46 44 Sex Males 19 22 14 Females 11 8 7 Total number of people in the study 81 Published data indicates a higher crash rate in the under 18 and over 75 Legal age to obtain a driving license in SA is 18

  5. RANGE OF REFRACTIVE ERROR ABK RSBH • Range -0.50 - 23.00 -0.25 - 14.75 0 – 19.00 • 0.50 to 8.00 0.25 to 8.50 0.75 to 3.00 • > Cyl -6.00x88 -7.00x60 -4.25X9

  6. VISUAL ACUITY WITH BEST SPECTACLE CORRECTION • Best Eye 20/40 - 20/50 • Weaker Eye 20/200 - NLP

  7. Pathology of clients TOTAL ALBINISM 15 STARGARDTS 14 MACULAR 13 CONG CATARACTS 3 DIABETES 3 NYSTAGMUS 9 OPTIC ATROPHY 10 OTHER 13 Total 81 • TOTAL

  8. pathology

  9. Primary uses of Bioptic ABK RS BH • DRIVING 26 28 18 • OTHER 4 2 3 • WHY THE NEED FOR BIOPTICS • The ability to drive contributes strongly to one’s quality of life • To meet the criteria of legally obtaining a driving license

  10. Technical details of Bioptics prescribed • Magnification ABK RS BH 2.2 x - 2 2 • 3.00 x 8 14 2 • 4.00 x 22 14 17 • Monocular 5 27 20 • Binocular 25 3 1 • Type of Bioptic • Designs for Vision 27 30 21 • Occutech 3 - -

  11. VISUAL ACUITY WITH BIOPTIC • V A with Bioptic SA 20/15 - 20/50 • V A with Bioptic USA 20/40 - 20/50 • Bioptic population USA20/50 – 20/200 • Bioptic population SA 20/15 - 20/400 • What is important is that quantitative measures should give way to qualitative measures

  12. DRIVING STANDARDS SA USA Visual acuity 20/40 20/40 Visual field 140 total 140 total Visual acuity if 20/30 one eye blind Field with one 115 total eye blind Facts from the USA re driving with a Bioptic Unrestricted license ---- 20/30 - 20/70 With road evaluation ---- 20/100 - 20/200 Restricted license ----- 20/100 e.g. time of day; area

  13. Documentation required by authorities in granting a licence to Bioptic clients SA USA Uncorrected VA Y Y Corrected VA Y Y Peripheral fields Y Y Stability of pathology N Y Depth Perception N Y Color Vision N Y Ability to co-ordinate head N Y neck and eye movement Contrast sensitivity glare - N Y recovery luminance

  14. THE BASIC GUIDELINES ADOPTED IN PRESCRIBING BIOPTICS • A driving licence is a privelege and not an automatic right • Visual acuity and Visual fields • The will to drive • Age; Health • Must master the dynamic skills essential for driving with a bioptic eg cognitive sensory motor and scanning skills; good eye – hand co-ordination • Binocular if possible • Stability of pathology

  15. THE WAY FORWARD • UFOV computer testing for the LV client • Reduce reliance on the present acuity for legal driving • The clients visual & functional performance with the bioptic should be the main factor in granting a licence • Standardised tests for cognitive motor and sensory functioning • Driving instructors who are educated in the problems associated with disabilities • 2 – 3 yr follow up

  16. IS SOUTH AFRICA DIFFERENT ? • Visual acuity with the bioptic is similar • Legal driving standards re vision and fields are similar • The onus for prescribing a bioptic for driving in SA rests on the optometrist • The USA optometrist has more guidelines in reaching a decision • Training in the use of a bioptic rests heavily on the optometrist

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